2
Key Points
➤ If follow-up is available, the Expert Panel recommends cone biopsy
for women with stage IA2 disease in basic settings and cone biopsy
plus pelvic lymphadenectomy in limited settings. In enhanced and
maximal settings, radical trachelectomy is recommended for patients
with stage IB1 cervical cancer with tumor size ≤2 cm who desire
fertility-sparing surgery.
➤ In basic settings where patients cannot be treated with radiation
therapy, extrafascial hysterectomy either alone or after chemotherapy
may be an option for women with stage IA1 to IVA cervical cancer.
➤ In basic settings, for women with larger tumors or advanced-stage
cervical cancer, neoadjuvant chemotherapy is recommended,
whenever chemotherapy is available, for the purpose of shrinking the
tumor before performing hysterectomy.
➤ Concurrent radiotherapy and chemotherapy is standard in enhanced
and maximal settings for women with stage IB to IVA disease.
➤ The panel stresses the addition of low-dose chemotherapy during
radiotherapy but not at the cost of delaying radiation therapy if
chemotherapy is not available.
➤ In limited-resource settings where there is no brachytherapy, the
ASCO Expert Panel recommends extrafascial hysterectomy or its
modification for women who have residual tumor 2–3 months after
concurrent chemoradiotherapy and additional boost.
➤ For patients with stage IV or recurrent cervical cancer, single-agent
chemotherapy (carboplatin or cisplatin) is recommended in basic
settings.
➤ If the resources are available and the patient cannot receive
treatment with curative intent, palliative radiotherapy should be used
to relieve symptoms of pain and bleeding.
➤ Where resources are constrained, single- or short-course radiotherapy
schemes can be used with retreatments if feasible for persistent or
recurrent symptoms.
➤ Palliative care and pain management are part of the treatment of
cancers, including cervical cancer, to avoid unnecessary suffering
during the final stages of disease. Pain control is a vital component of
palliative care, a basic human right often neglected in cancer control
programs.
